Catheter salvage from central line-related bloodstream infections in pediatric intestinal failure

ObjectivesPatients with intestinal failure require central venous access which puts them at risk for central line-associated bloodstream infections (CLABSI). Maintaining vascular patency is critical for this population to receive nutrition support. When CLABSIs occur line salvage can help maintain vascular access. The aim of this study is to assess factors associated with safe and successful central venous catheter salvage.MethodsRetrospective cohort study of patients with intestinal failure at two tertiary care institutions between 2012 and 2020. The study examined the rates of attempted salvage, factors associated with successful salvage, and complications associated with salvage attempts.ResultsOver the study period, 76 patients with intestinal failure were include while central venous access was in place. There were a total of 94 CLABSIs. Salvage was more likely to be attempted when patients were under the direct care of an intestinal rehabilitation service (95% vs. 68%, p = 0.04). The overall successful salvage rate was 91.6% (n = 77). Gram-positive, Gram-negative, and polymicrobial infections had successful salvage rates of 97%, 92%, and 94% respectively. The successful salvage rate for fungal infections was 40%. There was no difference in 30-day complication rates for hospital readmission, intensive care unit admission, and death between patients who underwent salvage attempt and those who did not.ConclusionsCentral line salvage can be safely attempted for many infections in patients with intestinal failure, leading to vascular access preservation. image What is Known Patients with intestinal failure require central vascular access to receive nutrition and fluids. Central vascular access is associated with increased risk of serious infection. Preservation of vasculature is critical for patents with intestinal failure.What is New Line salvage in the setting of central line-associated bloodstream infections is effective for line preservation in most cases. Fungal infection are less likely to successfully be salvaged, other hard-to-treat infections have higher successful salvage rates including polymicrobial infections, and Staphylococcus aureus infections. Salvage attempts are not associated with increased complications at 30 days.